Duritecs.docx

AL-Warith University Nursing Faculty Pharmachology 2 // lecture Prepared by Dr. Nassim Samir Ali Saker 2020 Groups: Group Examples Thiazide diuretics Chlorothiazide, Indapamide ,chlorthalidone, hydrochlorothiazide, Loop diuretics Bumetanide, Furosemide, and torsemide) K-sparing diuretics Spironolact...

AL-Warith University Nursing Faculty Pharmachology 2 // lecture Prepared by Dr. Nassim Samir Ali Saker 2020 Groups: Group Examples Thiazide diuretics Chlorothiazide, Indapamide ,chlorthalidone, hydrochlorothiazide, Loop diuretics Bumetanide, Furosemide, and torsemide) K-sparing diuretics Spironolactone , Amiloride, Triamterene, Osmotic diuretics (Mannitol) Carbonic anhydrase inhibitors Acetazolalide General Use Congestive heart failure, Hypertension Liver cirrhosis Renal failure, Nephrotic syndrome Thiazide diuretics and loop diuretics are used alone or in combination in the treatment of hypertension or edema due to CHF or other causes. Potassium-sparing diuretics have weak diuretic and antihypertensive properties and are used mainly to conserve potassium in patients receiving thiazide or loop diuretics. Osmotic diuretics are often used in cerebral edema. Interactions T Additive hypokalemia with corticosteroids, amphotericin B, piperacillin, Hypokalemia enhances digitalis glycoside toxicity. Additive hypotension with other antihypertensives or nitrates. Potassium- sparing diuretics may cause hyperkalemia when used with potassium supplements or ACE inhibitors. S Thiazide and Related Diuretics Action: Thiazide diuretics are synthetic drugs that are chemically related to the sulfonamides and differ mainly in their duration of action. chlorothiazide is the only one that can be given IV. Thiazides and related diuretics are frequently prescribed in the long-term management of heart failure and hypertension. They act to decrease reabsorption of sodium, water, chloride, and bicarbonate in the distal convoluted tubule. Most sodium is reabsorbed before it reaches the distal convoluted tubule and only a small amount is reabsorbed at this site. Thus, these drugs are not strong diuretics. In addition, they are ineffective when immediate diuresis is required (because of their slow onset of action) and relatively ineffective with decreased renal function. Loop Diuretics Action: Loop diuretics inhibit sodium and chloride reabsorption in the ascending limb of the loop of Henle, where reabsorption of most filtered sodium occurs. Thus, these potent drugs produce significant diuresis, with their sodium-losing effect up to 10 times greater than that of thiazide diuretics. Loop diuretics may be given orally or IV. After oral administration, diuretic effects occur within 30 to 60 minutes, peak in 1 to 2 hours, and last 6 to 8 hours. After IV administration, diuretic effects occur within 5 minutes, peak within 30 minutes, and last about 2 hours. Loop diuretics are the diuretics of choice when rapid effects are required (eg, in pulmonary edema) and when renal function is impaired Potassium-Sparing Diuretics Action This group includes three drugs. One is spironolactone, an aldosterone antagonist. Aldosterone is a hormone secreted by the adrenal cortex. It promotes retention of sodium and water and excretion of potassium. Spironolactone blocks the sodium-retaining effects of aldosterone, The other two drugs, amiloride and triamterene, act directly on the distal tubule to decrease the exchange of sodium for potassium, Potassium-sparing diuretics are weak diuretics when used alone. Thus, they are usually given in combination with potassium-losing diuretics to increase diuretic activity and decrease potassium loss. They are contraindicated in the presence of renal insufficiency because their use may cause hyperkalemia through the inhibition of aldosterone and subse Osmotic Diuretics Action Osmotic agents produce rapid diuresis by increasing the solute load (osmotic pressure) of the glomerular filtrate. The increased osmotic pressure causes water to be pulled from extravascular sites into the bloodstream, thereby increasing blood volume and decreasing reabsorption of water and electrolytes in the renal tubules. Mannitol is useful in managing oliguria or anuria, and it may prevent acute renal failure during prolonged surgery, trauma, or infusion of cisplatin, an antineoplastic agent. Mannitol is effective even when renal circulation and GFR are reduced (eg, in hypovolemic shock, trauma, or dehydration). Other important clinical uses of hyperosmolar agents include reduction of intracranial pressure before or after neurosurgery, reduction of intraocular Nnursing implications Assessment Assess fluid status throughout therapy. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Assess patient for anorexia, muscle weakness, numbness, tingling, paresthesia, confusion, and excessive thirst. Notify health care professional promptly if these signs of electrolyte imbalance occur. Monitor blood pressure and pulse before and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension. Increased Intracranial Pressure: Monitor neurologic status and intracranial pressure readings in patients receiving osmotic diuretics to decrease cerebral edema. Increased Intraocular Pressure: Monitor for persistent or increased eye pain or decrease visual acuity. Lab Test Considerations: Monitor electrolytes (especially potassium), blood glucose, BUN, and serum uric acid levels before and periodically throughout course of therapy. Thiazide diuretics may cause increased serum cholesterol, low-density lipoprotein (LDL), and triglyceride concentrations. Potential Nursing Diagnoses Excess fluid volume (Indications). Implementation Administer oral diuretics in the morning to prevent disruption of sleep cycle. Many diuretics are available in combination with antihypertensives or potassium-sparing diuretics. Patient/Family Teaching Instruct patient to take medication exactly as directed. Advise patients on antihypertensive regimen to continue taking medication, even if feeling better. Medication controls, but does notcure, hypertension. Caution patient to make position changes slowly to minimize orthostatic hypotension. Caution patient that the use of alcohol, exercise during hot weather, or standing for long periods during therapy may enhance orthostatic hypotension. Instruct patient to consult health care professional regarding dietary potassium guidelines. Instruct patient to monitor weight weekly and report changes. Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions. Advise patient to contact health care professional immediately if muscle weakness, cramps, C nausea, dizziness, or numbness or tingling of extremities occurs. T Evaluation/Desired Outcomes S Decreased blood pressure. Increased urine output. Decreased edema. Reduced intracranial pressure. Prevention of hypokalemia in patients taking diuretics. Treatment of hyperaldosteronism.